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Ottawa Ankle and Foot Rules

"Learn how to quickly and accurately assess ankle and foot injuries in the Ottawa Region with the Ottawa Ankle & Foot Rules. Get all the information in this helpful video!"

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Transcript

00:04 - 00:07This is running the brook Bush Institute in this video. We're gonna go
00:07 - 00:10over the Ottawa ankle and foot rules, my friend. Evette's going
00:10 - 00:15to come out. She's gonna be our case study. We're gonna pretend that that
00:13 - 00:16just ran a
00:16 - 00:19half marathon which is kind of hilarious because she hates Endurance Sports
00:19 - 00:22about as much as I do personally. I love endurance
00:22 - 00:25athletes, but I wouldn't run an event like that or maybe
00:25 - 00:28she just sprained her ankle real bad playing like
00:28 - 00:31soccer or basketball or something now, she's come
00:31 - 00:34to see me. All right her physical therapist who she's seen before
00:34 - 00:37and of course the first thing I want to check for might be
00:38 - 00:41did she actually fracture her foot? So knowing
00:41 - 00:44these Ottawa ankle rules helps you rule out
00:44 - 00:46whether somebody needs an X-ray or not.
00:47 - 00:51Now it starts with this does the person have malleolar pain
00:51 - 00:53or mid foot pain?
00:54 - 00:57That's how this this little algorithm starts. So
00:57 - 01:01do they have this or this right malleoler
01:00 - 01:01mid foot pain?
01:02 - 01:04Can she bear weight?
01:05 - 01:08If she can't bear weight, this is the day of the
01:08 - 01:11day after right we're talking immediately after this event.
01:12 - 01:13Center for an x-ray
01:14 - 01:17so we that that's a good indication that that there
01:17 - 01:19is a potential for fracture there now.
01:20 - 01:23Let's say she has Mallory pain or
01:23 - 01:26mid-foot pain and she can bear weight.
01:26 - 01:29It's just kind of uncomfortable now. We
01:29 - 01:30need to take the next step.
01:31 - 01:34For ankle type stuff maybe an ankle fracture. We're
01:34 - 01:37gonna go ahead and palpate the posterior tips.
01:38 - 01:42of hermaleola, and the reason we're going to go to the posterior tips
01:41 - 01:44of the malleoli is we want
01:44 - 01:46to stay away from the bottom of the malleoli because
01:47 - 01:50if she had like a soft tissue injury like an ankle sprain
01:50 - 01:53that might be tender anyway, for example, if
01:53 - 01:56she had an inversion Sprain and strain some
01:56 - 02:00of those those lateral ligaments we'd get a false positive
01:59 - 02:02here and it might be
02:02 - 02:05positive for ligament damage, but
02:05 - 02:08what we're looking for is fracture. So we're going to come to these
02:08 - 02:11posterior poles and if they're tender upon
02:11 - 02:12palpation,
02:13 - 02:13x-ray
02:14 - 02:17Right, so we started off with malleolar pain.
02:18 - 02:21Could she bear weight if not x-ray if
02:21 - 02:25she can bear weight but has posterior
02:24 - 02:28malleolar pain X-ray. Let's
02:27 - 02:30go more to foot here. Now. Let's say
02:30 - 02:33she has mid foot pain. She can bear weight.
02:34 - 02:34but
02:35 - 02:39if I either press on her navicular, right,
02:39 - 02:42so this is her navicular tubercle right here. If you
02:42 - 02:45guys fall off the medial malleoli both inferior, and
02:45 - 02:48then just anterior. There's a bump here if I press on her
02:48 - 02:48navicular.
02:49 - 02:51and that hurts or
02:52 - 02:55I press on her fifth metatarsal head and you
02:55 - 02:56guys can just feel the fifth metatarsal.
02:57 - 03:00And then there's like it comes to a bumpy end right here.
03:01 - 03:05All right. So again a little inferior and anterior to
03:04 - 03:07her lateral malleoli if either of those points are
03:07 - 03:07tender.
03:08 - 03:09x-ray
03:10 - 03:13All right, so I'm gonna take you guys through this
03:13 - 03:15again. Maybe I'll take you through it seperately.
03:16 - 03:16ankle
03:17 - 03:18malleolar pain
03:20 - 03:22if they can't bear weight on that foot.
03:23 - 03:23x-ray
03:24 - 03:26Malleolar pain but they can bear weight.
03:27 - 03:30But it's tender on the posterior poles.
03:31 - 03:31x-ray
03:33 - 03:34malleolar pain
03:36 - 03:39can bear weight no pain on posterior poles. You're
03:39 - 03:42probably okay. You can probably go forward with
03:42 - 03:45treatment and see how things go if you
03:45 - 03:47still get some Weird Science guys, don't
03:48 - 03:51Be totally irrational like if they're not getting
03:51 - 03:54better refer out, I mean you guys use your
03:54 - 03:57use your heads use common sense now foot.
03:58 - 03:59mid foot pain
04:00 - 04:03she comes in she can't bear weight on this foot x-ray.
04:04 - 04:07Mid foot pain can bear weight on the foot. But if
04:07 - 04:09I press on the navicular
04:10 - 04:11or the fifth metatarsal head
04:12 - 04:15then and there's pain x-ray now
04:15 - 04:17if I have mid foot pain.
04:18 - 04:21She can bear weight I can palpate there's no
04:21 - 04:21pain.
04:22 - 04:25Probably okay to get a few sessions before you
04:25 - 04:28reassess again if there's anything weird refer out,
04:28 - 04:31but if she's progressing well then we keep
04:31 - 04:31going.
04:33 - 04:36so all in all guys are Ottawa
04:36 - 04:39ankle rules, you can think of it almost as trying to
04:39 - 04:42keep ourselves safe as physical therapists atc's human
04:42 - 04:47movement professionals, whichever, you know, what ot's osteopaths,
04:45 - 04:48whatever whatever part of
04:48 - 04:51this profession you're in if somebody comes to
04:51 - 04:52you before seeing a physician
04:53 - 04:56off of an acute injury to their lower extremity.
04:56 - 04:59Right. You want to check them for
04:59 - 04:59fracture?
05:00 - 05:03You're going to use these rules to help determine whether you're
05:03 - 05:06going to first refer out or whether you
05:06 - 05:07can go ahead and treat.
05:08 - 05:11If you guys have any questions, please let me know in the
05:11 - 05:12comments box below.

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